尼莫地平治疗蛛网膜下腔出血患者的临床研究  

Clinical trial of nimodipine in the treatment of patients with subarachnoid hemorrhage

作　　者：邱平[1] 沈东炜[1] 官林燕 廖雪燕 QIU Ping;SHEN Dong-wei;GUAN Lin-yan;LIAO Xue-yan(Second Department of Neurosurgery;Department of Radiology,Longyan First Hospital,Longyan 364000,FujianProvince,China)

机构地区：[1]龙岩市第一医院神经外科二科,福建龙岩364000 [2]龙岩市第一医院放射科,福建龙岩364000

出　　处：《中国临床药理学杂志》2024年第22期3234-3238,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的分析脑池内灌注尼莫地平对蛛网膜下腔出血(SAH)后迟发性脑血管痉挛(DCVS)的预防效果及安全性。方法将行颅内动脉瘤夹闭术治疗的SAH患者按照队列法分为对照组与试验组。对照组术后给予稀释血液、扩容、升压等基础治疗,发现DCVS后静脉泵注尼莫地平注射液2.5^5.0 mL·h^(-1);试验组在对照组治疗的基础上,术后脑池内持续灌注尼莫地平溶液(尼莫地平注射液:复方氯化钠注射液=1∶19)48 h,泵注速度20 mL·L^(-1),2组疗程均为14 d。记录2组患者术后3、5、7和14 d DCVS发生率,比较2组患者治疗前及治疗14 d后神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]、意识状态[格拉斯哥昏迷量表(GCS)评分]、血清DCVS发生机制指标[血小板源性生长因子受体β(PDGFRβ)、基质金属蛋白酶-9(MMP-9)、前列环素I_(2)(PGI_(2))、纤维蛋白降解产物(FDP)],记录迟发性脑缺血等术后并发症发生情况,在术后3个月用改良Rankin量表(mRS)评估2组患者预后情况,并进行安全性评价。结果本研究对照组入组39例,试验组入组43例。试验组与对照组术后3 d的DCVS发生率分别为25.58%和48.72%,5 d的DCVS发生率分别为20.93%和43.59%,7 d的DCVS发生率分别为13.95%和38.46%,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。治疗14 d后,试验组与对照组NIHSS评分分别为(2.08±0.43)和(2.96±0.52)分,GCS评分分别为(13.22±0.48)和(12.36±0.50)分,血清PDGFRβ分别为(70.22±5.97)和(74.86±6.54)ng·mL^(-1),MMP-9分别为(189.44±17.23)和(213.95±16.81)ng·mL^(-1),PGI_(2)分别为(96.18±5.84)和(89.44±6.27)ng·L^(-1),FDP分别为(1.62±0.50)和(2.13±0.48)mg·L^(-1),试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组的术后迟发性脑缺血发生率为4.65%,显著低于对照组的23.08%(P<0.05)。术后3个月,2组患者均未出现死亡病例,试验组与对照组的mRS分Objective To analyze the preventive effect and safety of intracisternal perfusion of nimodipine on delayed cerebral vasospasm(DCVS)after subarachnoid hemorrhage(SAH).Methods SAH patients treated with intracranial aneurysm clipping were divided into control group and treatment group according to cohort method.The control group was given basic treatment such as blood dilution,volume expansion and pressure boosting after operation.After DCVS was found,nimodipine injection 2.5-5.0 mL·h^(-1)was injected intravenously.The treatment group was given continuous perfusion of nimodipine solution(nimodipine injection:compound sodium chloride injection=1:19)for 48 h in the cerebral cistern on the basis of the control group,and the pumping speed was 20 mL·L^(-1).The course of treatment in both groups was 14 days.The incidence of DCVS was recorded at 3,5,7 and 14 days after operation.The neurological function[National Institutes of Health Stroke Scale(NIHSS)score],state of consciousness[Glasgow Coma Scale(GCS)score],serum DCVS mechanism indexes[platelet-derived growth factor receptorβ(PDGFRβ),matrix metalloproteinase-9(MMP-9),prostacyclin I_(2)(PGI_(2)),fibrin degradation product(FDP)]were compared between the two groups before treatment and 14 days after treatment.The occurrence of postoperative complications such as delayed cerebral ischemia was recorded.The prognosis of the two groups was evaluated by modified Rankin scale(mRS)at 3 months after operation,and the safety was evaluated.Results In this study,39 cases were enrolled in the control group and 43 cases in the treatment group.The incidence of DCVS in the treatment group and the control group were 25.58%and 48.72%at 3 days after operation,20.93%and 43.59%at 5 days after operation,and 13.95%and 38.46%at 7 days after operation,respectively.The above indexes in the treatment group were significantly different from those in the control group(all P<0.05).After 14 days of treatment,the NIHSS score of the treatment group and the control group were 2.08±0.43 and 2.96±0.5

关 键 词：尼莫地平注射液 蛛网膜下腔出血 迟发性脑血管痉挛 灌注 预防 并发症 预后 

分 类 号：R972[医药卫生—药品]